Background Hypertensive urgency is associated with a high risk for cardiovascular events and mortality in the US and Europe, but data from low-income countries and interventions to improve outcomes are lacking. Methods We conducted a one-year prospective study of the prevalence and outcomes of hypertensive urgency (BP ≥180 mmHg/120 mmHg without end organ damage) in a busy outpatient clinic in Tanzania. Results Of 7600 consecutive adult outpatients screened with 3 unattended automated blood pressure measurements according to standard protocol, the prevalence of hypertensive crisis was 199/7600 (2.6%) (BP ≥180 mmHg /120 mmHg) and the prevalence of hypertensive urgency was 164/7600 (2.2%). Among 150 enrolled patients with hypertensive urgency, median age was 62 years [54-68], 101 (67.3%) were women and 53 (35%) were either hospitalized or died within one year. In a multivariate model, the strongest predictor of hospitalization/death was self-reported medication adherence on a 3 question scale (HR: 0.06, p<0.001); 90% of participants with poor adherence were hospitalized or died within one year. Conclusions Patients with hypertensive urgency in Africa are at high risk of poor outcomes. Clinicians can identify the patients at highest risk for poor outcomes with simple questions related treatment adherence. New interventions are needed to improve medication adherence in patients with hypertensive urgency.

We report a case of disseminated cryptococcosis in a 42-year old immunocompetent female. Prior to admission at Bugando Medical Center, the patient was attended at three hospitals for hypertension and clinically diagnosed malaria. Following diagnosis of disseminated Cryptococcus at our center, she was successfully treated with fluconazole but remained with visual loss. Blood cultures should be considered in the management of any adult presenting with fever to enable early detection of the least expected differentials like in this case.